Social Care

Kevin Hollinrake Excerpts

Wednesday 25th October 2017 Commons Chamber

[Barbara Keeley]

I will talk about how the Labour party will take forward proposals on the future of social care. We wait to hear what the Government choose to do. My hon. Friend is right that there is a driving need now.

The number of people—1.2 million—living with unmet care needs will inevitably rise without an injection of new funding. A lack of publicly funded care means that the task of meeting care needs falls more heavily on unpaid family carers. Many carers have to give up work because of the demands of caring, which has a real impact on their finances and future career prospects. The case for listening to carers and giving them more support is overwhelming. We were expecting a new carers’ strategy this spring, or, at the latest, in the summer. Some 6,500 carers had taken the time over and above their caring responsibilities to respond to the Government’s consultation. However, the Care Minister told me that the responses will merely be taken forward into a new consultation on social care.

Katy Styles, a carer and a campaigner for the Motor Neurone Disease Association, contributed to that consultation and hoped that her voice would be heard, alongside 6,500 other carers. She told me:

“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth.”

That is a shabby way to treat carers—the people who provide more than 50% of the care in this country.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The hon. Lady refers to unpaid carers. Labour’s motion references the Communities and Local Government Committee report on adult social care, which looked at the German system of social insurance. Under that system, payments are made to family members to remunerate them for that care. Has she read that report, and is it something that she is willing to look at in further detail on a cross-party basis?

[Barbara Keeley]

I will come on later to discuss how we should proceed and whether we should proceed on a cross-party basis. The hon. Gentleman’s point about carers and family carers is important. The plain fact of the matter is that there was nothing for carers in his party’s manifesto. We had announced that we were going to lift carer’s allowance at least to the level of jobseeker’s allowance. That is the only improvement that was discussed during the general election. He should turn to his own Minister and his own party and ask them what they will do for carers.

--- Later in debate ---

[Jackie Doyle-Price]

I am not very impressed by the tale that the hon. Lady describes, but I would like to look into it more directly and get back to her.

The Government have already invested an additional £2 billion to put social care on a more stable footing and alleviate short-term pressures across the health and care system. However, further long-term reform is required to ensure that we have a sustainable system for the future—one equipped to meet the challenges of the increasing numbers of people with care needs. To address these questions, the Government will work with partners—including those who use services, those who work to provide care, and all other agencies—to bring forward proposals for public consultation. The consultation will cover a wide range of options to encourage a very wide debate. It will set out options to improve the social care system and put it on a more secure financial footing, supporting people, families and communities to prepare for old age, and it will address issues related to the quality of care and variation in practice. It will include proposals on options for caps on overall care costs and means-tested floors. It is, however, a consultation, and the Government wish to approach the future of social care in the spirit of consensus. Our consultation is designed to encourage a grown-up conversation in order that society can rise to this challenge.

[Kevin Hollinrake]

The Minister refers to a number of options that the Government will consider. Will they also consider the suggestion contained in that Select Committee report of a system of social insurance, which would be sustainable and simple and would deal with some of the points raised about adults of working age with learning disabilities? The scheme would cover all those things and provide protection for people who are on low incomes. It seems to work very effectively in Germany, where it garnered cross-party support when it was introduced.

[Jackie Doyle-Price]

I agree that we want to learn from examples in other countries. As I have said, the spirit of the consultation will be to allow a well-informed debate, as a result of which consensus can be established. In view of that, we will consider a wide variety of options, covering not just funding but lifestyle solutions and other issues.

--- Later in debate ---

[Kevin Hollinrake (Thirsk and Malton) (Con)]

It is a pleasure to follow the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), who made a good point about the sustainability of providers, an issue to which I shall return shortly.

I was pleased to see the Communities and Local Government Committee report on adult social care listed as a document relevant to the motion. I serve on the Committee and contributed to that report. We established what I think we are all aware of: there is a demographic time bomb with respect to social care. The King’s Fund said that there are hundreds of thousands of people in their 80s and 90s and that the number grew by third in the past 10 years and will double in the next 20 years.

The problem is not going to go away and there is no doubt that, as a result, the system is under pressure. This is about not only the overall numbers of people affected but the individual devastation. The shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley), referred to “catastrophic care costs”, which is a fair way to put it. It cannot be right that one person and their family can be affected in such a catastrophic way if they have long-term care needs such as dementia. We need to consider the impact on their family and the financial consequences of those catastrophic costs.

It is not right for either the Government or the individual to have a blank cheque on this issue, so we need to look for a different solution. When most of us see a potentially catastrophic risk, we insure ourselves against it. As part of its adult social care inquiry, the Select Committee visited Berlin to look at the German system. Adult social care in Germany was previously funded by local government, but a social insurance system was introduced in 1994. Every person has to pay into the system, although there is a threshold so that low earners are taken care of and do not have to pay. Everyone else pays around 1.2% of their salary, with their employer also contributing. It is a bit like auto-enrolment, but for social care.

The system in Germany has been successful. It was introduced with cross-party agreement, which is what has been called for today by Government and Opposition Members alike and which I absolutely support. In Germany, if care is needed, the money paid out of insurance policies can be paid to family members, so the social fabric element of social care is catered for, because more families look after their relatives when they are in need—they are not unpaid carers; they are actually paid. The German system helps the provision of the right kind of support from the right people, and I really hope that the Government will consider it as a permanent, sustainable, scalable and simple solution to this problem.

Baby Loss Awareness Week

Kevin Hollinrake Excerpts

Tuesday 10th October 2017 Commons Chamber

[Kevin Hollinrake (Thirsk and Malton) (Con)]

It is a pleasure to follow the hon. Member for Slough (Mr Dhesi), who talked very touchingly about his own family experiences when they were affected by this terrible issue. It is also a privilege and an honour to speak in this debate in Baby Loss Awareness Week. Obviously it is humbling to hear all the different stories from fellow Members and parents on these Benches—they are such harrowing stories—and the bravery with which they are able to communicate them and raise this issue.

This is the most harrowing thing that can happen to any parent. I speak as a parent of four children, one of whom is about to reach his 21st birthday, but this is a fear that will never leave any of us, whatever age our children are. Although we got to four children, we had a number of mishaps and miscarriages along the way, and the hope for those affected is that as more children come along the way, that pain eases a little bit.

It is a pleasure to have the opportunity to introduce my own private Member’s Bill to deal with some of these issues—actually, I have merely been passed the baton by my hon. Friend the Member for Colchester (Will Quince), who has done so much work on this. My private Member’s Bill would allow parental bereavement leave. We heard an incredible story from my hon. Friend the Member for East Renfrewshire (Paul Masterton), who talked about an employer who would not let somebody affected by this terrible tragedy have time off work. That is absolutely outrageous, but the reality is that in those circumstances—the death of a child—there is no statutory requirement for an employer to let staff have time off. I cannot imagine the distress that that must cause people affected by these terrible tragedies—tragedy upon tragedy—or how terrible the effect must be on the workforce of that employer, with everybody having to hear about it.

Most employers, of course, do not take that approach. I speak as an employer, both here—we are employers in this place—and in my life before Parliament. As an employer, we would not need the Government or anybody else to tell us to give people affected by this tragedy leave. Of course we would do that, and we would pay them whatever pay they were due. Sadly we cannot be that generous in our private Member’s Bill, but I encourage all Members please to attend the Second Reading debate on my Bill next Friday, to contribute and to make sure that we look at all the issues and circumstances. It is wonderful to hear that people are willing to share their circumstances, because it will help us to make sure that the legislation is in the right place.

The Bill would require all employers to provide at least two weeks’ leave for all staff affected by this kind of tragedy. I am delighted that the Government are supporting the Bill, which gives us a very good chance, given the extended time we have to get it through—unfortunately my hon. Friend the Member for Colchester was unable to get it through in the last Session because of time constraints. It fits very neatly with the Government’s pledge to enhance rights and protections in the workplace, so it is exactly where we need to be. Making sure that every employer provides such protections for people in their time of loss is the least we can do.

I thank my hon. Friends the Members for Colchester, for Eddisbury (Antoinette Sandbach) and for Banbury (Victoria Prentis) for their tremendous work in this area. Over the summer months, we have been working with employers, charities and unions to make sure that we get the legislation to the right place, as I am keen to do. The legislation will help bereaved parents not just of babies but of children all the way up to their 18th birthday.

I am sure that we all have touching stories from our own experience, or from constituents who have come to us. Some members of the all-party group will be familiar with Annika and James Dowson, and with Luke and Ruthie Heron. The Dowsons lost their little child, Gypsy, who was stillborn. The Herons lost Eli after 23 weeks and six days, but he managed to survive for another two and a half days. Had he not done so, their loss would have been classed as a miscarriage rather than a stillbirth. They are championing the need to look at the legislation in that regard, and Annika and James put all their efforts into raising money for a bereavement suite in Scarborough. There are some tremendous and touching stories of the hope that has come out of these tragedies. If the Bill eases the unimaginable pain of just one family, our collective efforts will be worthwhile.

Oral Answers to Questions

Kevin Hollinrake Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

I do understand the concerns raised, and all hospitals are under a responsibility to make sure that they have proper arrangements in place for people on low incomes and people who have to visit hospitals regularly.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Antibiotic resistance is a major threat to humanity. Will the Minister outline the progress we have made in opening up the £50 million global antimicrobial resistance innovation fund to applications?

[Steve Brine]

I thank my hon. Friend for that. We expect the first launch to be the bilateral UK-China partnership £10 million fund, which we expect to go live early in 2018. Further information on the calls for the remaining £40 million will be announced in due course.

Contaminated Blood

Kevin Hollinrake Excerpts

Thursday 20th July 2017 Commons Chamber

[Jackie Doyle-Price]

To be clear, the Department of Health is the sponsoring Department for the inquiry, which will be entirely independent. It is yet to be determined who will oversee it. Clearly, having made the statement and expressed our intention to hold an inquiry, we need to consult to make sure that that inquiry reflects on and answers the hon. Gentleman’s questions. Central to that will be the need for it to be seen to be transparent, open and fully independent. Once it is established, the inquiry will be entirely removed from the Department of Health. That should be enough to inspire confidence, provided we get the consultation right so that we get the remit right.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Two of my constituents who were affected by this terrible tragedy have already contacted me with concerns about the Department of Health’s involvement in the inquiry. This is a unique situation, especially with respect to the time it has taken to bring forward the inquiry, and credit should go to the Government for announcing it. Nevertheless, it is incredibly important that justice is seen to be done, so will the Minister consult members of the all-party group on haemophilia and contaminated blood with regard to who she determines are the right people to oversee the scope of the inquiry?

[Jackie Doyle-Price]

I am keen to hear from all Members of the House and members of the public on how they feel the inquiry should be taken forward. That is the spirit in which we are embarking on this consultation.

Contaminated Blood

Kevin Hollinrake Excerpts

Tuesday 11th July 2017 Commons Chamber

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I, too, start by paying tribute to the hon. Member for Kingston upon Hull North (Diana Johnson) for her leadership and persistence on this issue, on which she and my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi) have done tireless work. I welcome the Minister’s statement that a public inquiry will happen on this most important of issues. The Prime Minister has clearly listened to views across the House on the matter.

At one of my first surgery appointments, Richard and his wife came to see me to tell me his story. Richard was a haemophiliac who was sent to a school for the physically disabled in Hampshire when he was 11. For six years, he was given hundreds of thousands of units of factor VIII. Prior to that he had been given cryoprecipitate, which was perfectly workable in moderating his condition. The factor VIII prophylactic treatment was meant to prevent the dangers caused by haemophilia. It changed Richard’s life. Sadly, 64 of the 75 people from Richard’s school are no longer with us. Many of those young people died in their early teens.

This case is a double tragedy. Richard and his wife told me the very good news that, in later life, they decided to have children, but due to the risk of his hepatitis affecting the unborn baby, they had to have a termination, so they are childless as well as having been affected by terrible diseases throughout their lives.

I neglected to congratulate the hon. Member for Oxford East (Anneliese Dodds) on her very fine maiden speech. She certainly made a far better job of it than I did of mine when I stood here two years ago. Her tremendous words were highly relevant to the topic under discussion. I am sure she will make many further fine contributions in the years ahead.

[Mark Pawsey (Rugby) (Con)]

Does my hon. Friend agree that the inquiry needs to consider the challenges faced by people affected by contaminated blood who want children? A constituent of mine had one round of IVF treatment covered by the NHS, but he was not entitled to a second round, so he had to pay for it himself. We should consider such issues and their effect on people in the round.

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[Kevin Hollinrake]

My hon. Friend is absolutely right. These terrible diseases have so many tragic implications. Through no fault of their own, people did not know that the treatments would have an adverse impact on their health.

Helen was infected in the 1980s, but it was only when she moved to my constituency in 2006 and registered with a new GP that she was diagnosed with hepatitis and its associated difficulties. She has had many consequent health problems, including four strokes, diabetes and rheumatoid osteoporosis. It has had a huge impact on her life. She calls her health a “ticking time bomb”. She had to relocate back from France after trying to set up a new life there with her husband and two children.

I have spoken to both of those constituents today. It is incredible how lightly they seem to carry their burdens. They have moved on from the principal issue, which was compensation, and what they want now is a public inquiry to get to the bottom of this. It is about getting answers. I am not saying that compensation is not important—it is hugely important, particularly for their spouses and children—but today they want answers.

[Rebecca Pow (Taunton Deane) (Con)]

My hon. Friend is making a very good case. Does he agree that, while we welcome the Government’s inquiry and the funding given so far, transparency should be at its core? That is what it is all about.

[Kevin Hollinrake]

I absolutely agree. The Minister may confirm at the end of the debate, if he gets the chance, that the Government have released all the relevant documents in their possession. It is absolutely right that there should be full transparency and that key witnesses who were involved in this tragedy should be interviewed.

One of the biggest outstanding questions is: what was known? Helen told me that, despite the fact that she did not find out until 20 years after she was infected, the hospital had known for years. That is a tragic set of circumstances.

Richard sent me a passage that he found during his research. As early as 1975, Dr Joseph Garrett Allen, then professor of surgery at Stanford University in California, wrote to Dr William Maycock, then head of the transfusion service in the UK, to warn him of the severe dangers of using US-pooled plasma sourced from paid skid-row donors and prisoners. He said that the situation was extraordinarily hazardous.

My constituents want answers to the following questions. What was known about the risks? Was Parliament informed about the change from self-sufficiency to imported products? What was found out and why were the products not withdrawn? Was it a cover-up or negligence? Did clinicians take a paternalist approach or was it simply incompetence?

I welcome the fact that this Government have done more than any other on compensation and transparency. I welcome the public inquiry and hope I can play my part in making sure that my constituents, their loved ones and everyone else affected by this terrible tragedy get answers.

[Several hon. Members rose—]

Oral Answers to Questions

Kevin Hollinrake Excerpts

Tuesday 4th July 2017 Commons Chamber

[Steve Brine]

The hon. Lady, who chairs the all-party group on suicide and self-harm prevention, does a huge amount of work in this area. The GP patient survey last year showed that 85% of respondents rated their GP experience as good. We are investing about £30 million of taxpayers’ money in the releasing time for care programme, which we hope will increase the time GPs can spend with patients on issues such as those she raises, but in my new role I am very happy to meet her.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

GPs are the first line of defence against antibiotic resistance, which has the potential to be an uncontrollable global new black death. Will the Minister confirm that the UK will retain its position as a world leader on this issue, and will he tell us when the global antimicrobial resistance innovation fund will open for applications and when the pilot reimbursement model for drug development will begin operating?

Health and Social Care Budgets

Kevin Hollinrake Excerpts

Tuesday 14th March 2017 Westminster Hall

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate. I would like to touch on three different elements of adult social care: the short, medium and long-term aspects of funding. In the short term, the Government have allowed revenue raising of nearly £14 billion since 2010; most recently, there was the £2 billion in the Budget. That was very welcome and has had an immediate impact on my constituency. North Yorkshire will see an extra £18 million over three years. While I very much appreciate that response to the various different submissions that have been made, I think that most people, including the Chancellor, accept that it does not provide a long-term solution.

The medium-term solution would be to look at business rates retention, which is coming down the line for 2020. A lot more money will be coming into the system, with £12.5 billion to local authorities. What bang for their buck the Government want for that, we do not quite know. The reality is that more money will be coming in, but the point has been made that the current distribution of local authority funding is not fit for purpose. There is no correlation between the need in local authorities and the amount of funding that goes in. It is based on an old formula—regression—and we need it to be based on cost drivers, which are around such things as age and deprivation.

We often fight the battle here between rural authorities and metropolitan authorities, but the battle we should be fighting is about the fact that the lion’s share of funding goes to London authorities. If we add up all the different elements, including the revenue support grant, business rates and council tax, total spending power in London is on average 40% higher than any other authority. Often those London authorities have lower need, younger populations and wealthier populations. There is no correlation, and I think we all want to see a fair system. I have nothing against London—it is a fantastic place—but I want a fair deal for North Yorkshire.

The other issue with business rates retention is the quantum. Will it grow to meet the need as need grows? The need is growing exponentially, and we need a longer-term solution. We have hugely increasing demand, and there needs to be correlation between need and the money coming in. In business, we always used to say when we came to such problems, “Ideas are ten a penny. We need a proven solution that is sustainable and scalable.” On our Select Committee visit to Germany, we saw that sustainable, scalable solution, which was delivered with cross-party agreement. I absolutely agree with the calls for us to tackle the issue on a cross-party basis.

O’Neill Review

Kevin Hollinrake Excerpts

Tuesday 7th March 2017 Westminster Hall

[Mr Gary Streeter (in the Chair)]

Before I call Mr Hollinrake to move the motion, I shall let you know that eight colleagues are trying to catch my eye, in addition to the Front Benchers and the mover of the motion, so I will impose a voluntary time limit of four minutes on Back-Bench speeches. Please—I beg you—keep interventions to a minimum. We will see how it goes. I may have to impose a compulsory limit as we go along, but I hope not.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I beg to move,

That this House has considered the O’Neill review into antibiotic resistance.

It is a pleasure to serve under your chairmanship, Mr Streeter. In advance of this debate, I penned an article for PoliticsHome titled, “Antibiotic resistance—the new Black Death?” As I was writing that headline, I could sense outraged people saying, “A typical politician grabbing a sensational headline to terrify the public once again,” but it reflects the devastating conclusions of the review on antimicrobial resistance, which involved some of the world’s leading scientists, academics and economists, including its chair, Lord O’Neill, the world-leading economist and former Treasury Minister.

The O’Neill review’s report states that bacteria are gradually becoming more resistant to antibiotics, and its most grim prediction is that 10 million lives will be lost globally every year by 2050. That is more than are lost to cancer and similar to the number of deaths caused in the 14th century by the black death, which killed some 75 million people between 1346 and 1353.

[John Howell (Henley) (Con)]

My hon. Friend cites 10 million deaths, but the effect will not be the same everywhere. Was he as shocked as I was to discover that the figure for Africa is more than 4 million? Does he think that more research should be done to ensure that the right resources are in the right places?

[Kevin Hollinrake]

My hon. Friend makes an excellent point. The key element of the fight against antimicrobial resistance is its global nature. We absolutely must not isolate ourselves from the rest of the world—we must collaborate—but we must take national action, too, and I will come on to that shortly.

That figure is of course a prediction—it could be lower, but it could also be higher. Predictions have been made about other contagions, such Ebola, Zika, HIV and Creutzfeldt-Jakob disease, and our scientists, academics and clinicians thankfully have managed to mitigate the worst effects and worst predictions for those diseases. But there are three reasons for us to be more alarmed this time: first, antimicrobial resistance is already happening; secondly, the problem is spreading rapidly and by all available means; and thirdly, research is not being carried out on anything like the scale required.

[Nick Herbert (Arundel and South Downs) (Con)]

A quarter of all the deaths that are predicted to happen as a result of drug resistance will be caused by tuberculosis, a disease that already kills 1.8 million people a year. Does my hon. Friend agree that research and development is essential if we are to develop a vaccine to prevent tuberculosis? No epidemic has ever been fully beaten without a vaccine.

[Kevin Hollinrake]

I absolutely agree. The difficulty is that due to the reward mechanisms in the system, such research and development is not happening. I will turn to that shortly.

This is not an apocalyptic prophecy. Antimicrobial resistance causes some 700,000 deaths globally and an estimated 12,000 deaths in the UK every year—similar to the number of people who lose their lives from breast cancer. Quite simply, if the bacteria that cause infections become resistant to antibiotics, people die. This issue is listed in the national risk register of civil emergencies, a five-year Government register, which states that an

“increasingly serious issue is the development and spread of”

antimicrobial resistance and points out that much of modern medicine will become unsafe. Minor surgery such as organ transplants, bowel surgery, cancer treatments and caesarean sections will become high risk—there will be more illness and more deaths.

Dame Sally Davies, our chief medical officer, pointed out that antibiotics have extended life by an average of 20 years—20 years of our lives may therefore be lost—and 40% of our population could die prematurely if this situation is not resolved. Operations would become unsafe due to the risk of infection during surgery or chemotherapy. Influenza pandemics would become much more serious. The national risk register states:

“The numbers of infections complicated by AMR are expected to increase markedly over the next 20 years. If a widespread outbreak were to occur, we could expect around 200,000 people to be affected by a bacterial blood infection that could not be treated effectively with existing drugs”.

[Mrs Theresa Villiers (Chipping Barnet) (Con)]

Does my hon. Friend agree that it is vital that we heed the O’Neill review’s recommendation that antimicrobial use in farming must reduce if we are to address the frightening consequences that he is outlining? In particular, we need to move away from intensive farming, which is reliant on the prophylactic use of antimicrobials.

[Kevin Hollinrake]

My right hon. Friend is right that bacteria can move from animals into humans, and the O’Neill review was clear that we need to take action in agriculture as well as our health services.

The national risk register states that we will be unable to treat some 200,000 people with existing drugs and

“around 80,000 of these people might die.”

That is a Government report.

[Julian Sturdy (York Outer) (Con)]

My hon. Friend is making a powerful argument. Is it not true that it takes about 15 years for a new antibiotic to get to the marketplace? Given the position that he has just laid out—deaths and resistance are happening already—that is quite frightening.

[Kevin Hollinrake]

My hon. Friend makes a very good point. We need to take action now because of the delays in producing new drugs.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on securing this important debate. Is it not self-evident that the prevention of the occurrence and spread of infection must be in the first line of the battle against this problem, and screening people on admission to hospital to determine who might be resistant and carrying infections would be very useful?

[Kevin Hollinrake]

The right hon. Gentleman is right. Some 50% of prescriptions are needless, and diagnostics would mean that a lot of drugs were no longer prescribed.

We talk glibly about tens of thousands of deaths—Stalin once said, “One death is a tragedy; a million is a statistic” —but the reality is that these are our partners, our brothers, our sisters and our children, so we must act.

[Rebecca Pow (Taunton Deane) (Con)]

My hon. Friend is making a powerful point, but is not the key to find new antibiotics? Is he aware that several antibiotics originated from organisms in soil? That is how penicillin was found, and the first lead on a new antibiotic was recently found in soil. Does he agree that protecting our soil is key to our future? Given how much soil is being eroded and degraded, the Government should treat that as an important issue.

[Kevin Hollinrake]

My hon. Friend is a fantastic champion of the natural environment, and she makes a very good point.

The World Health Organisation has stated that antimicrobial resistance is

“one of the greatest challenges for public health”

and that the problem is increasing and we are

“fast running out of…options.”

Antibiotic resistance is just one form of antimicrobial resistance—others concern viral and fungal infections—but my focus is antibiotics, which the public more readily understand and should have real concerns about. Bacteria undergo an eternal battle for survival, and natural resistance occurs as a result of bacteria fighting that battle, but when we use antibiotics—particularly when we overuse them—that natural resistance accelerates significantly and becomes super-charged, and we end up with many more antibiotic-resistant bacteria.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on bringing the debate. He is right to highlight the scale of the challenge not just here but globally: it is difficult for countries to bring forward large-scale programmes to deal with the problem of antimicrobial resistance. Does he agree that, apart from inappropriate prescribing, one of the key issues in this country is people not always completing courses of antibiotics, which increases the challenges and problems of bacteria developing resistance?

[Kevin Hollinrake]

I defer to my hon. Friend’s in-depth knowledge in this area. I recognise my father’s habits in taking antibiotics when he felt a bit unwell—he had a little cupboard in the corner of his lounge. That is a problem, and that is why we need to improve the education on treatment of illnesses for which people are prescribed antibiotics.

The point about antibiotic resistance spreading is that it can be spread in so many ways: on aeroplanes; in our water; from contact with unwashed hands of people who carry bacteria resistance; coughing and sneezing; and from animals to humans. Some Members may have come across the excellent BBC Radio 4 drama “Resistance” —the first episode was aired on Friday and the second episode is this Friday—which talks about the transference from animals to humans. That means we must tackle this problem both in agriculture and in our health services.

Bacteria do not recognise national borders, so, as many hon. Members have already pointed out, this is a global problem. We would think that with those apocalyptic visions of the future we would be spending an awful lot of money on tackling this issue, but that is not the case. About $100 billion is spent every year on cancer research, but only about $5 billion is spent every year on tackling antimicrobial resistance. The reason for that is the commercial return that large pharmaceutical companies will get from bringing forward a new antibiotic to tackle this issue. Almost by definition, any new drug is held as a last line of defence, so there is not a significant commercial return for the pharmaceutical companies who we rely on for such new drugs. About $50 billion a year is spent on antibiotics but only about $5 billion a year is spent on patented antibiotics, which is equivalent to one cancer drug. It is a better commercial activity to be involved in cancer research and cancer drug development than in antimicrobial resistance. There has been a huge reduction in the number of pharmaceutical companies involved in research and development—in 1990 there were 18 and in 2010 there were only four—and no new classes of antibiotic drugs have been developed in the past 25 years.

Of course, the O’Neill review has studied that and come up with clear and compelling recommendations such as rapid diagnostic testing, which the right hon. Member for Oxford East (Mr Smith) referred to. Yesterday we had a Twitter debate, which was interesting, listening for an hour to people’s experiences. Many clinicians got involved in that particular Twittersphere, and we trended nationally at one point, which was certainly a new experience for me. One thing that came across was the pressure that clinicians were under to prescribe antibiotics to people who felt ill. Obviously, if we had diagnostics that could show people that they did not carry something that could be treated by an antibiotic, they would be much less likely to put that pressure on doctors.

[Maggie Throup (Erewash) (Con)]

My hon. Friend makes a good point about educating patients so that they appreciate that they do not have to come out of the GP surgery with a prescription in their hand if a diagnostic test can be carried out to prove that antibiotics will not work in their case.

[Kevin Hollinrake]

That is right. I had a test myself at a drop-in session in Portcullis House that showed me that I was not ill—I did not think I was ill, but they told me that I was not, which was reassuring. Again, we need to ensure that prescriptions are given when they will be effective. One other area that we do not seem to have control over at the moment is the online sale of antibiotics: whether through UK-based pharmacies or those based overseas, it is too easy to access drugs without a proper prescription.

The second key point that the O’Neill review highlights is the need for a global public awareness campaign so that people are aware of the issues. Again on Twitter yesterday, a student who had undertaken some analysis said that 80% of the people she had spoken to had no awareness of antibiotic resistance. We need a significant national and international effort to draw public attention to the problem. As people have already said, we need a reduction of usage in agriculture. That is clearly set out in the O’Neill review as one of the four main recommendations.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

The hon. Gentleman is making an important point about the dangers of antibiotic resistance. Does he agree that as well as not prescribing antibiotics for illnesses, it is important to recognise when there are alternatives that will reduce the use of antibiotics overall? For example, there is research being done at Newcastle University into using antiseptics for urinary diseases.

[Kevin Hollinrake]

Yes, what we need is a mixture of solutions. The UK by its own admission is mid-range across Europe in its use of antibiotics in agriculture. That is one thing, but we have been world leaders on this issue and for me mid-range is not where we need to be; we need to be at the forefront and world leaders in terms of best practice, whatever aspect of this issue we are dealing with.

There are four key recommendations in the O’Neill review’s 10 main recommendations. The last one is on market entry rewards to solve the problem of pharmas not investing in research and development, as well as a possible levy on drug companies that do not invest in research.

[Alex Chalk (Cheltenham) (Con)]

The World Health Organisation has made it clear, chillingly, that resistance to last resort antibiotics is present globally, so we have to act. Does my hon. Friend agree that we will not create vital new drugs until we align better the public health needs with the commercial incentives, and that Governments need to correct what is the most dangerous market failure in history?

[Kevin Hollinrake]

That is correct, and the review sets that out clearly. At the moment, if there is not a commercial return, it is difficult for pharmaceutical companies to invest in this field, although some are. For example, AstraZeneca recently sold its late-stage small molecule antibiotic business to Pfizer and so stepped out of research and development, but others, such as MSD, are still investing. It cannot be right that some companies are willing to invest—perhaps for altruistic purposes—when others are not. The O’Neill review discusses whether there should be a reimbursement or an insurance model, so that pharmaceutical companies can be sure that they will get a certain amount every year for drugs if they do develop them. It cannot be right that some contribute and some do not, so a levy for those that do not seems sensible to me. I do not think it should be left simply to big pharma to solve the problem.

The O’Neill review talks about a global AMR innovation fund—GAMRIF—to make funding available for smaller third sector organisations. Having Antibiotic Research UK, the world’s first charity in this field, in my constituency is how the issue was brought to my attention. It is doing fantastic research. From donations made by individuals, it has got hundreds of thousands of pounds that it is investing in “resistance breakers”, which is blending drugs together to repurpose existing antibiotics. That again is one of the recommendations in the report. Yes, big pharma, but we have also got to make some funding available to the smaller organisations, too.

[Mr George Osborne (Tatton) (Con)]

Will my hon. Friend give way?

[Kevin Hollinrake]

I am happy to give way my right hon. Friend, who has been a leader on this issue globally.

[Mr Osborne]

I congratulate my hon. Friend on highlighting this issue, and the wide range of Members here shows the degree of support across the House. He is now on the nub of the problem: there will not be an international levy unless Britain leads the argument internationally; no other country will do it. David Cameron established the review and Jim O’Neill has provided the answers. The British Government now need to double up their efforts and make sure that this is one of the major things we campaign for at the UN, the G20 and the like. We have made a good start and we have an extremely capable Minister, but now we need to finish the job.

[Kevin Hollinrake]

I am grateful for that intervention and for my right hon. Friend’s work on the issue in the past. He gives me an ideal opportunity to close my comments; I know you are keen to get other Members in to speak, Mr Streeter.

The UK is a world leader on this in both words and actions, but we need to do much more. The former Prime Minister—and the current Prime Minister, I am sure—and the former Chancellor of the Exchequer are leaders on this on the world stage and have drawn it to the world’s attention, as has Lord O’Neill. It is hugely important that we maintain that leadership. I look forward to hearing the thoughts of colleagues and the clear plans of Ministers for how we will act now to meet today’s challenge, because the fear is that tomorrow will be much worse than today.

[Mr Gary Streeter (in the Chair)]

I remind hon. Members of the voluntary four-minute time limit. There are about to be Divisions in the House.

--- Later in debate ---

[Kevin Hollinrake]

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I thank the many colleagues who have contributed this afternoon to a very constructive debate; there has been a lot of consensus in this Chamber about what needs to be done. I also thank the Minister for her clear and comprehensive response to the many points that have been made; for the commitment she expressed at the end of her response, which is very reassuring; and, of course, for her great knowledge of this area.

It is quite clear from all the contributions that we have heard today that there is no one solution to this issue. There will have to be a holistic solution—a mix of solutions— across both the health and agriculture sectors; that point has been very clearly made this afternoon. That will also involve the different research laboratories that can contribute to this process. Obviously, the big pharmaceutical companies are a key element in making sure that we have the right remuneration mechanism for them and of course, our world-leading universities will also be involved, as well as other clinical institutions.

However, as I said earlier, the third sector is also important. Having the world’s first and only charity that specialises in combating antibiotic resistance in my constituency, I obviously feel honour-bound to support its fantastic activities. It is a collection of some of the UK’s top scientists. It has put an awful lot of work and money into this area, and its initial research has gone very well, using resistance breakers to repurpose antibiotics. Again, that is a key recommendation in the O’Neill review. As I say, the charity is making this progress and it is absolutely desperate to get the right kind of support. Any help we can give, in terms of pointing Antibiotic Research UK in the right direction to get the sources of funding it needs, would be useful. Its approach is innovative. It perhaps does not meet all the criteria that would normally be applied for this kind of research, but I absolutely believe that ANTRUK is certainly part of the short-term solution to this problem, if not the longer-term solution.

As others have already done, it is right that I thank Lord O’Neill for his tremendous work, as well as all the other people who contributed to his report. It is fair to say from what we have heard this afternoon that all the questions and answers are in the report; we just need to ensure that we execute well and follow through on the recommendations in the report.

As my right hon. Friend the Member for Tatton (Mr Osborne) said, leadership is a key part of this issue. We were very lucky with the former Prime Minister and the former Chancellor, who put it front and centre. They took global action and showed global leadership on it, which is critical. With leadership, all things are possible; there is no question about that. It is incredibly important that we continue to show that leadership in Parliament and Westminster.

It was tremendous to have so many contributions to this debate, not only from the Minister and former Ministers, who have so much knowledge of this area, but from those who have shown leadership at the highest possible level. It is great to see the UK front and centre, speaking out on this important issue on the world stage.

I thank you again, Mr Hollobone, for your time. It has been a pleasure to serve under your chairmanship and to contribute to this very important debate.

Question put and agreed to.

Resolved,

That this House has considered the O’Neill review into antibiotic resistance.

Health and Social Care

Kevin Hollinrake Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Betts]

We heard quite a lot of evidence that, as a percentage of our national income, we do not spend as much as several others on health and social care combined. The Communities and Local Government Committee will reflect on that. Of course, it is not simply a question of asking for more public funding; I would not come to that conclusion, although I might personally believe it. There is, however, an issue with where we get the private funding from, because nobody has argued to us so far that the whole of social care can be publicly funded. There will be private contributions, so how do we raise that private money? Should it come from individuals who simply need care at that point in time, or should we ask people to pay more into an insurance system? How do we put in more money from the public sector? Indeed, can we rely on local authority funding alone, particularly if it comes largely from business rates, which will not grow at the same rate as the number of people who want social care?

[Kevin Hollinrake (Thirsk and Malton) (Con)]

rose—

[Dr Murrison]

rose—

[Mr Betts]

I give way to my Select Committee colleague, the hon. Member for Thirsk and Malton (Kevin Hollinrake).

[Kevin Hollinrake]

It was a pleasure to join the hon. Gentleman and other members of the Select Committee on that visit. Does he agree that the German example is all the more pertinent given that its system was also funded by local authorities prior to the change to social insurance in 1995? It discovered 20 years ago that that system was not fit for purpose and moved to a new system that, as he says, has cross-party support and is a long-term, sustainable solution.

[Mr Betts]

I just want us to have a process that gets us to a similar position. Even if local authorities remain part of the funding solution, we cannot assume that the increase in business rates and council tax will keep pace with the level of demand.

I know that you have encouraged us to keep to a time limit, Madam Deputy Speaker.

--- Later in debate ---

[Kevin Hollinrake (Thirsk and Malton) (Con)]

It is a pleasure to follow the hon. Member for West Lancashire (Rosie Cooper), who made some interesting points, particularly about fundamental reform of services, which I will address later in my remarks.

Members on both sides of the House have alluded to the fact that this debate is set against the background of hugely increasing demand and, in many ways, decreasing supply, particularly in adult social care, to which I will restrict my comments. I was interested to take part in the Communities and Local Government Committee inquiry, to which the Chair, the hon. Member for Sheffield South East (Mr Betts), referred. On increasing demand, there was a 33% increase in the past 10 years in the population who are aged 80 and over. There is a projected 100% increase in that population over the next 20 years, and a 50% increase in 65s and over in the same period. Interestingly enough, there will be only a 4% increase in the population who are below the age of 65 over the next 20 years. That is an interesting dynamic when we think about who will provide the care that will be needed for all the people who are getting older.

An area of adult social care we can sometimes forget—it has not been mentioned—is care for those with learning disabilities. That population is increasing rapidly and will increase again over the next 20 years, which means more profound challenges for our health and adult social care services.

On the backdrop of the decreasing supply of provision, everybody has to take part in ensuring that the books balance. We are reducing the deficit from £156 billion a year in 2010 to around £68 billion this year, which is no mean feat. We must understand that there is no bottomless pit, and that we have to make difficult decisions on allocating our spending.

Local authorities have borne the brunt of the 37% reduction in overall spending—it is a 25% reduction after council tax increases. Adult social care accounts for around 33% of local authority discretionary spend. It is therefore inevitable that that will be a focus when local authority managers try to balance the books. There are other competing pressures, such as the national living wage, which soaks up a lot of the extra money allocated to adult social care. It is not just about local authorities: providers are also under huge pressure. Some 59% of care homes are below the profitability threshold. Homes are closing and some providers are returning their contracts to local authorities.

There are other elements relating to the provision of what we would call a well-functioning health and social care service. Other reductions include a 28% reduction in the number of community nurses, who provide the key services that stop people going into the health and social care system. In my constituency, simple things like sitting services, local dementia clubs or something called Kurt’s Club in my hometown of Easingwold have either closed or had services reduced in recent weeks and months. Again, that puts more pressure on the system.

Delayed discharges also have an impact on the NHS. Hon. Members who spoke earlier know far more about this than I do, but when Simon Stevens gave evidence to our Committee he estimated that the NHS spends up to an extra £1 billion due to delayed discharges. There is an impact on the whole system.

The Government have responded with £2 billion more since 2010, with the adult social care precept, the better care fund and the adult social care grant adding between £3.5 billion and £4 billion by 2020. There is no doubt, however, that all the evidence we have heard from a number of different sources—the King’s Fund and the like—points to an investment shortfall of between £1 billion and £2 billion.

[Alex Chalk (Cheltenham) (Con)]

On the shortfall, does my hon. Friend agree that the time has come to bite the bullet and increase social care funding? Does he agree that doing so in the short term would provide the financial headroom to enable trusts like mine in Gloucestershire to achieve the meaningful reconfiguration of services through the STPs that will reflect the changing health priorities and demographics? It is a sprat to catch a mackerel.

[Kevin Hollinrake]

My hon. Friend makes a very strong point. I do feel that we need more money now. I am sure the question of whether more money might be available is taking up some of the Chancellor’s time as he works on his Budget calculations for 8 March. In the short term, we need more money to plug the gap. In the longer term, we need a cross-party conversation on how we solve this problem.

The Select Committee has been an excellent forum through which to explore this issue and many others. As the hon. Member for Sheffield South East (Mr Betts), the Committee Chair, mentioned in his remarks, we went to Germany to examine its system. It was very enlightening. In 1995, Germany moved from one system to another: from a local government-funded system that just did not work—they clearly saw this coming before we did—to a social insurance system. They are more used to that system in Germany, which has similar systems in place for health, pensions, unemployment and accident insurance. It works very well. It is cross-party, seems to be apolitical and takes a salary contribution of about 1.175%. It is a bit like auto-enrolment, but it is compulsory—it is a mandatory scheme. It means that when people need care they have a pot to call on. Needs are independently assessed, so they receive the level of provision that suits them. It can also be used to provide domiciliary care. Money coming back out of the system at the right time can go to help family members look after the person who is ill, so it has a social benefit as well as being a sustainable system that works in the longer term. We should look at that model. It is not the only one, but I reiterate—I know Members on both sides of the House feel the same way—that we should look at this issue in a cross-party way to ensure long-term sustainability.

[Kevin Foster (Torbay) (Con)]

I am very much enjoying my hon. Friend’s speech. Does he agree that the current method of local government funding does not help? There is a ward in my constituency where 9% of the population are aged over 85. Demographics are not properly reflected and the challenges faced by coastal communities in particular, as opposed to some of the more traditional challenges here in London, are not reflected in funding schemes.

[Kevin Hollinrake]

My hon. Friend makes a very good point. The evidence clearly shows that the current methods of funding adult social care do not correlate with the needs in those areas. We need to take a strategic look at that. The Government are moving toward a different way of funding local authorities by 2020. A key part of business rates retention is the consideration of the allocation of funding. It is critical to put need first and foremost, so that need and the cost of delivering services are the cost drivers. Having a fair and transparent system is fundamental.

On adult social care and learning disabilities, one of the most heartening examples of how to deliver them in a different way, rather than looking at them from a single viewpoint, is the Botton Village “shared lives” concept, where people look after each other—co-workers and people in need of care alike. It is a fantastic and inspirational scheme.

Finally, I will touch on a couple of very small points. We should look at how people are charged for domiciliary care. Financial assessment for domiciliary care is different from that for residential care. I think money could be taken out of the system—it does not make much sense to me that the Government fund one thing one way and another thing another way—or people could contribute, if their houses are taken into account in their domiciliary care assessment.

My final point relates to co-terminosity. There are so many different services provided by so many different agencies working in different geographical boundaries. Co-terminosity works well in Sheffield, where all the agencies work together very effectively. In my area, it is completely different. There is a real mish-mash of different providers and geographical areas, which makes it difficult to provide a joined-up service.

--- Later in debate ---

[Steve McCabe]

I don’t think I need any lectures on cross-party dialogue from the party of the death tax and the £8 billion financial fib.

In Birmingham, we have seen £28 million cuts to the social care budget, bringing the service to its knees. Elderly people are being treated like cattle, lying around on trolleys, waiting in corridors and dispatched from hospital in the middle of the night. Everywhere we look, we see our hospitals, GPs and social care services collapsing under the strain.

This Secretary of State is quite happy to flex his muscles when it comes to bullying junior doctors, but it is always someone else’s fault when it comes to resources, management and administration of the NHS. There was a time when the deal was simple: in return for the red box and a ministerial salary, Ministers took responsibility —the buck stopped with them. But no more. I have lost track of how many parliamentary answers begin with the words, “The Department does not collect that data centrally,” or “It would not be cost-effective to provide information in that format”. Basically, Ministers do not know, do not want to know and do not want us to know what is really happening. They no longer preside over a genuinely national health service. Whether it is the postcode lottery that characterises the provision of IVF, with clinical commissioning groups ignoring NICE guidelines and making up their own criteria as they go along, or children’s dentistry, where there is a growing crisis and a heavy reliance on hospital emergency surgery because of the lack of provision and monitoring of proper dental services for children, all this Government want to do is hide behind and blame others for their shambolic decisions.

The latest disaster is the business rates revaluation, which in Birmingham is estimated to see a rise for University Hospitals Birmingham’s Queen Elizabeth hospital from £2.8 million to £6.9 million per year—talk about robbing Peter to pay Paul! And yet Ministers from the Department for Communities and Local Government and the Department of Health have not even met to discuss the problem—although I note that private hospitals get an 80% reduction because they are registered as charities.

In my constituency, we have been fighting a battle to save our Katie Road walk-in centre for several years: we have had stop-go consultations, money wasted, explanations and excuses that vary from month to month, consultations announced and then scrapped, and now we have a sustainability and transformation plan that sadly, as acknowledged, has turned into a secret strategy drawn up by non-elected bureaucrats from which the public and their elected representatives have been largely excluded. It seems that Katie Road is now caught up in this fiasco. With its contract scheduled to finish on the 31st of next month, we still do not know what is happening, although if rumours are true, even more money that ought to be spent on healthcare in Birmingham is about to be siphoned off to rescue bankrupt neighbours.

Only the other week, I discovered that the contract for South Maypole GP services was to be cancelled. It is apparently no longer cost-effective—not cost effective to provide GP services to the sick and elderly! Only under this Secretary of State could the NHS have come to this.

[Kevin Hollinrake]

In my remarks, I talked about a cross-party conversation. I could easily have pointed out that between 2011 and 2014 there was an 8.6% real-terms drop in health spending in Wales, under a Labour Administration, while there was a 4% increase in England, but would it not be better to have a constructive conversation about how we take the NHS and social care off the front pages of the tabloids and to sit down and work out a solution together?

[Steve McCabe]

It is always desirable to have that conversation when the Tories are in power. When Labour is in power, we talk about death tax campaigns and we hear about £8 billion funding fibs. It is funny how the argument always changes when they are responsible.

As I was saying, the contract for South Maypole GP services is about to be withdrawn. I found that out not when the CCG, which it turns out has been ruminating on this since November, told me, but when I was contacted by anxious constituents who had just found out they had eight weeks to find a new GP. Many of them are elderly people, and some have long-term conditions and rely on regular medication, but they are dismissed as if they do not matter. The loss of their GP service is treated like the closure of a local hairdresser or petrol station. They are told to shop around. Apparently the CCG thinks there are enough GPs in the area—enough at any rate to satisfy their little diagrams and tables on their secret little plans. Reducing demand for acute care is one of the Government’s plans to ease pressures in the NHS. Exactly how do we achieve that by closing walk-in centres and GP surgeries? Is that not the fastest route to our already overstretched A&E departments?

It is not just the estimates at issue here, but a proper long-term plan for the NHS and social care. This Secretary of State has failed us. His stewardship is a disaster. Rather than accepting more of it, the House should be calling for a motion of censure. The Government and the Secretary of State are presiding over the steady dismantling of the country’s greatest peacetime achievement. It is a total disgrace.

Oral Answers to Questions

Kevin Hollinrake Excerpts

Tuesday 20th December 2016 Commons Chamber

[Nicola Blackwood]

The hon. Gentleman is a great advocate of evidence-based medicine and I am pleased to hear about his support for it. He will be pleased that the national leadership programme is one of the evidence-based programmes that we are rolling out to improve the leadership of the NHS across the country.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

3. How the Government plan to show global leadership in tackling antimicrobial resistance.

[Mrs Theresa Villiers (Chipping Barnet) (Con)]

12. How the Government plan to show global leadership in tackling antimicrobial resistance.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

The UK is already a global leader in the fight against AMR. This Government’s leadership has secured a UN declaration on AMR and a commitment from the G20 to drive the development of new antimicrobials. We will continue to deliver international programmes to tackle AMR, including the Fleming fund and the Global AMR innovation fund, which represent more than £300 million of investment over the next five years.

[Kevin Hollinrake]

One of the 10 key recommendations of the O’Neill review was to improve the data and surveillance underlying antimicrobial resistance. What plans does the Minister have to routinely test all NHS patients for antibiotic resistance?

[Nicola Blackwood]

My hon. Friend is absolutely right that it is essential that we improve diagnostics if we are to tackle this national threat. A routine part of the clinical management of patients showing symptoms of infections is to take a blood sample. When an infection is identified, those samples are indeed tested for resistance. Part of our AMR strategy is to improve diagnostics and to fund innovation in this area.